For a study, researchers sought to assess the impact of anesthetic care handovers on postoperative morbidity and death.
It was a parallel-group, randomized clinical study that took place at 12 centers between June 2019 and June 2021 (final follow-up, July 31, 2021). Participants were eligible if they had an American Society of Anesthesiologists physical status of 3 or 4 and were scheduled for major inpatient surgery lasting at least 2 hours. A total of 1,817 individuals were randomly assigned to either a complete handover to another physician for anesthesia treatment (n=908) or no transfer of anesthesia care (n=909). There was no common handover mechanism employed by any of the collaborating universities.
A 30-day composite of all-cause death, hospital readmission, or significant postoperative complications was the main outcome. The experiment included 1,772 patients (98%; mean age, 66 [SD, 12] years; 997 males [56%]; and 1,717 [97%] with an American Society of Anesthesiologists physical status of 3). In the handover group, the median total length of anaesthesia was 267 minutes (IQR, 206-351 minutes), while the median time from commencement of anaesthesia to first handover was 144 minutes (IQR, 105-213 minutes). The composite primary outcome occurred in 268 of 891 patients (30%) in the handover group and in 284 of 881 (33%), respectively (absolute risk difference [RD], -2.5%; 95% CI, -6.8 % to 1.9%; odds ratio [OR], 0.89; 95% CI, 0.72 to 1.10; P=.27). All-cause 30-day mortality occurred in 19 of 889 patients (2.1%) in the handover group and 30 of 873 (3.4%) in the no handover group (absolute RD, -1.3 %; 95% CI, -2.8% to 0.2% ; OR, 0.61; 95% CI, 0.34 to 1.10; P=.11); 115 of 888 (13%) vs 136 of 872 (16%) were readmitted (absolute RD, −2.7%; 95% CI, −5.9% to 0.6%; OR, 0.80; 95% CI, 0.61 to 1.05; P =.12); and 195 of 890 (22%) vs 189 of 874 (22%) experienced serious postoperative complications (absolute RD, 0.3%; 95% CI, −3.6% to 4.1%; odds ratio, 1.02; 95% CI, 0.81 to 1.28; P= .91). There was no significant difference between the 19 predetermined secondary end points.
In the composite primary outcome of mortality, readmission, or serious postoperative complications within 30 days, there was no significant difference between patients randomised to receive handover of anaesthesia care from one clinician to another versus the no handover group among adults undergoing extended surgical procedures.
Reference: jamanetwork.com/journals/jama/article-abstract/2793288
